Healthcare Provider Details

I. General information

NPI: 1861673303
Provider Name (Legal Business Name): BRUCE D. HOPPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 E LANCASTER AVE
BRYN MAWR PA
19010-1451
US

IV. Provider business mailing address

1030 E LANCASTER AVE
BRYN MAWR PA
19010-1451
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-3225
  • Fax: 610-525-4932
Mailing address:
  • Phone: 610-525-3225
  • Fax: 610-525-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD008757E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: